Print version ISSN 0036-4665
Rev. Inst. Med. trop. S. Paulo vol. 39 no. 1 São Paulo Jan./Feb. 1997
A FOCUS OF FAVUS DUE TO TRICHOPHYTON SCHOENLEINII IN RIO GRANDE DO SUL
Shirley M.W. MATTE, Jorge O. LOPES, Ivanir S. MELO & André A. COSTA BEBER
MATTE, S.M.W.; LOPES, J.O.; MELO, I.S. & COSTA BEBER, A.A. A focus of favus due to Trichophyton schoenleinii in Rio Grande do Sul. Rev. Inst. Med. trop. S. Paulo, 39(1):000-000, 1997.
This paper reports the ocurrence of a focus of favus due to Trichophyton schoenleinii affecting seven members of a family, 29 years after the last register of the disease in Rio Grande do Sul.
KEYWORDS: Favus; Trichophyton schoenleinii; Rio Grande do Sul.
Favus is a chronic infection with a dermatophyte fungus characterized by dense scutulum composed of mycelial masses and epithelial debris in hair follicles12. Clusters of infected follicles may caused matting of the hari, and after a period of years atrophy of the skin occurs, leaving a permanent alopecia. In most all cases, favus is caused by Trichophyton schoenleinii. This dermatophyte is endemic in Africa and Central Europe, but foci restricted to members of a single family had been reported in the Western hemisphere. These foci are associated to descendants of ancestors who emigrated from endemic area9. Whe report the occurrence of a focus of favus due to. T. schoenleinii affecting seven members of a family, 29 years after the last register of the disease in Rio Grande do Sul (RS).
A 22-year-old married white female, bom and living in 15 de Novembro county, RS, came to the Dermatology Departament of the Santa Maria University Hospital with a 15 years history of alopecia. The patient was a nourish hygienic woman, and refered the occurence of an acute severe inflammatory infection of the scalp when she was 7-year-old. She revealed that ther father age 49, her sisters age 19 and 14, her brothers age 9 and 5, and a first cousin age 19 have similar lesions. The origin of the disease was assigned to her great-grandmother, who immigrated from Germany, and had similar disease. On physical examination several areas of cicatricial alopecia could be seen on the scalp, but furfuraceous lesion on temporoparietal left region was observed (Fig. 1). Scales collected from the lesion and mounted in 10% potassium hydroxide demonstrated irregular branched septate hyaline hyphae. Hair pulled from the lesion revealed mass of fragmented hyphae surrounding hair near mouth of follicle, and hyphae within the hair, showing characteristic channeling of T. schoenleinii hair infection. Scales and hair cultured on Mycobiotic agar (Difco) incubated at 25°C, produced slow growing gray colonies, with raised center and irregularly folded surface (Fig. 2). On microscopic examination characteristic favic chanderlier were seen. A scalp biopsy revealed inflammatory and reparative alteration, with adnexal atrophy, related to hair infection by a dermatophyte (Fig. 3).
Examination of her husband was normal, her sister age 19 revealed only cicatricial alopecia, but her brothers and cousin presented similar pityroid lesions with direct and cultural results positive for T. schoenleinii. Terbinafine in a dose of 125 mg and 250 mg per day in children and adult respectively, was the drug prescribed. Only the 22-year-old woman adhered to the treatment.
Favus due to T. schoenleinii is usually a family-centered infection that may affect many generations. In familiar focus patients with cicatricial alopecia live together with patients that have a milder form of the disease, named pityroid form. This clinical form is indistinguishable from a seborrheic form of tinea capitis, and contrast with the acute severe infection, characterized by dense scutulum formation, or the impetiginous form. The variation in severity of forms represent an immune response specific to each infected patient, involving T-helper/T-supressor lymphocyte interactions3. The resulting immune anergy could explain the long standing noninflammatory pityroid form observed in the present report. On the other hand, the symptomless or occult. T. schoenleinii infection, represented by and accomodation and equilibrium to the host, increase duration of survival, dissemination, and chronicity of the infection13. The definitive proof of occult infection would require biopsy for the demonstration of fungi withing the hair shaft.
In Rio Grande do Sul favus was first reported by ASSIS2 in 1928. MENDES11 in 1962 reported an epidemic focus in Jaguari county, whose agent was studied by FABRICIO et al.7 FISCHMAN et al.8 in 1963 reported two familiar foci in Jaguari and Santiago, affecting 54 patients. LONDERO et al.10 in a ten-year-survery of dermatophytosis diagnosed the disease in 1964, in four children of a family living in Jaguari, known as an endemic area. BOOP & LEIRIA5 in 1967 reported the disease in 47 patients in Candido Godoi country. From that time T. schoenleinii was considered erradicated in Rio Grande do Sul, and only in three occasions the infection was reported in the rest of Brazil1, 4, 6.
Um foco de favo por T. schoenleinii no Rio Grande do Sul
É relatada a ocorrência de um foco de favo por T. schoenleinii afetando sete pessoas em uma família, 29 anos após o último registro da doença no Rio Grande do Sul.
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Recebido para publicação em 25/10/1996
Aceito para publicação em 08/01/1997
Hospital Universitário de Santa Maria. Universidade Federal de Santa Maria, Rio Grande do Sul.
Correspondence to: Jorge O. Lopes. Departamento de Microbiologia e Parasitologia. Universidade Federal de Santa Maria, 97119-970 Santa Maria, RS, Brazil.